MEDICARE: MARTHA HELENA GUTIERREZ M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1245386127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA HELENA GUTIERREZ M.A.

Provider Business Mailing Address
First Line	:	350 N STANLEY PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2991
Country	:	US
Telephone Number	:	480-705-4512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 E VIRGINIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1324
Country	:	US
Telephone Number	:	602-381-6120
Fax Number	:	602-381-6125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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